Culture Shock: Thinking Positive on World AIDS Day

The HIV/AIDS pandemic rages on, but there are still some blessings to be counted.

by Michael Smith Michael Smith North American Correspondent, MedPage Today
December 01, 2013

Culture Shock is a blog by Michael Smith for readers with an interest in infectious diseases.

World AIDS Day has always come hard on the heels of Thanksgiving, at least in the U.S. It's just a coincidence, of course. Canada had its Thanksgiving a month and a half ago and the rest of the world doesn't give thanks much anyway, at least not on a special day.

But let's count some blessings on the HIV/AIDS front anyway.

First of all, Congress has just re-authorized PEPFAR, the President's Emergency Plan for AIDS Relief. That was expected -- PEPFAR is as close as it gets to a bipartisan project these days -- but it's still a good thing.

Granted, you don't want to transplant organs from someone with HIV to someone without, but within the HIV-positive population, there should be no bar. Currently, organs from potential deceased donors with HIV are thrown away, which is a shocking waste.

On the research side, the CDC is reporting that the risk of sexual acquisition of HIV remains high among men who have sex with men. Well, no surprise there. But the good news, the agency said, is that risky behavior is much lower among men who have been tested and know their HIV status.

But on a wider scale, let's talk Obamacare. The Affordable Care Act, for all its widely publicized warts, is already changing the face of HIV care in the U.S.

I had a long chat with Alice Thornton, MD, medical director of the Bluegrass Care Clinic at the University of Kentucky in Lexington last week. I was trying to get a feeling for how HIV care providers are feeling this World AIDS Day.

She's "very excited" about the ACA, she said, because it means that the 45% of the clinic's 1,100 patients with no insurance will finally have some. It has been a challenge, she said -- she and her staff have had to get up to speed on the act and how it works.

But as of last week, they had helped about a third of those uninsured patients navigate the wild waters of the ACA sign-up process. "We still have a way to go," she told me, but they're hoping to get many of the rest insured in the next few weeks.

It's not that people weren't getting HIV care -- the Bluegrass Care Clinic, like most HIV facilities across the country, finds ways to cobble together financing to cover most of the costs. But it was pretty much restricted to day-to-day outpatient care for HIV-related things. Have a car crash or a stroke and all bets were off.

Her patients are now heaving a "huge sigh of relief," Thornton told me, because they can see a future in which a non-HIV medical emergency is not an economic catastrophe.

I don't know how widely that applies. Anecdote is not evidence. But I hope that Thornton's experience -- and that of her patients -- is being reflected across the country. And if so, I'm truly thankful.

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